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Continuing problems with pressure ulcers in hospitals and care homes


    Information on the present campaign to reduce the numbers of patients suffering from pressure ulcers and considering practical steps that can be undertaken by hospitals and care homes.

    By Ben Lees

I have been keeping up-to-date with the Association of Personal Injury Lawyers (APIL) campaign to eliminate pressure ulcers in hospitals, and was shocked to read recently that the occurrence rate for these the ulcers can vary from 0% to over 50% depending on the hospital trust.

Data published by APIL demonstrates that some NHS hospital trusts are allowing pressure ulcers to reach critical levels up to 51% of the time. Meanwhile, other trusts are managing to prevent the occurrence of critical level pressure ulcers altogether. This variation suggests that there is a failure by some trusts to adequately risk assess and treat patients who are susceptible to these ulcers. So, what more can be done to improve the standard of care afforded to the patients who are affected and reduce problems with pressure ulcers?

What are pressure ulcers?

Pressure ulcers are a type of injury that breaks down the skin and underlying tissue. They are caused when an area of skin is placed under sufficient pressure to disrupt blood supply to that area and typically they occur in a person confined to bed or a chair by an illness. They are also sometimes known as “bedsores” or “pressure sores” [1].

Pressure ulcers can range in severity from patches of discoloured skin to open wounds that expose the underlying bone or muscle, and they are graded accordingly from 1 to 4. Grade 3 and grade 4 pressure ulcers would usually be regarded as severe/critical.

How are pressure ulcers prevented?

The latest guidelines published by the National Institute for Health and Care Excellence (NICE – April 2014) recommend a number of measures to prevent pressure ulcers which include, but are not limited to:

1.    A thorough risk assessment of patients, including a re-evaluation of risk every time there is a change in the patient’s clinical status (immediately after surgery for example);

2.    Encouragement to patients to re-position themselves at least every 6 hours;

3.    The use of pressure redistributing devices and barrier creams.

What practical steps can be taken to improve standards and drive down the occurrence rate of pressure ulcers?

The Clinical Negligence Team fully supports the 5 step plan proposed by APIL to tackle the preventable problem of pressure ulcers. The specific steps proposed in the plan are as follows:

1.    Government support for the roll-out of the NHS Midlands and East ‘Stop the Pressure
Campaign’ to all care providers.

2.    Mandatory training of staff on the relevant NICE guidelines in all settings where patients or residents could suffer from a pressure ulcer. Training records should be kept by the Trust or care home, and training should be refreshed at least every three years.

3.    A dedicated tissue viability nurse for care homes in each county.

4.    A named individual or job role to be allocated to ensure appropriate care is provided for each person with an identified pressure ulcer, or known to be at risk.

5.    Data collection, analysis and publication standards should be agreed nationally, alongside the introduction of a regime of independent spot-checking of the statistics and recorded gradings to ensure compliance and consistency. Associated penalties should also be introduced for non-compliance and false recording in order to encourage compliance.

Step 2 is particularly important in my view. Uniformity in training and expectations for staff by reference to the NICE guidelines would ensure a more evenly distributed and generally lower occurrence rate for pressure sores across hospital trusts in England and Wales.

As a further incentive, if needed, to implements APIL’s 5 step plan, it should also be noted that a failure to take appropriate steps to prevent pressure ulcers is an expensive one. The cost to the NHS of treating pressure ulcers and related conditions is up to £4 billion a year, with the most severe cases ranging from £11,000 to £40,000 per person (according to the NHS England, pressure ulcer best practice leaflet).

Our experience

Lawyers in the Clinical Negligence Team have extensive experience of representing patients, and the relatives of patients, who have suffered pressure ulcers as a result of inadequate hospital care.  These pressure ulcers can often be debilitating to a patient who is already ill or has undergone surgery and can really set back recovery time and therefore anything further that can be done to prevent them should be done.

If you have any concerns about the medical care you or a family member have received which has resulted in a pressure ulcer, and would like to discuss this with a specialist lawyer, please get in touch with me or one of my colleagues.

[1] NHS Choices website


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